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| __NOTOC__
| | #Redirect [[Pulmonary embolism embolectomy]] |
| {{Pulmonary embolism}}
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| {{CMG}}
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| ==Overview==
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| In [[thoracic surgery]], a '''pulmonary thrombectomy''', is an [[emergency procedure]] that removes [[blood clot|clotted]] [[blood]] ([[thrombus]]) from the [[pulmonary artery|pulmonary arteries]]. Embolectomy can be done via a catheter or surgically.
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| ==Indications==
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| *Pulmonary embolism patient (formed from venous embolisms). Embolectomy is used for patients with persisting shock despite supportive care and who have an absolute contraindication for thrombolytic therapy.
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| ==Types==
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| *Catheter embolectomy
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| **Rheolytic embolectomy
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| **Rotational embolectomy
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| *Surgical embolectomy
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| ==Description==
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| '''Rheolytic embolectomy''': Pressurized saline is passed through a catheter's distal tip, which breaks-down the emboli. The saline and clot fragments are then sucked back into an exhaust lumen of the catheter and disposed off.
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| Insertion of a large catheter increases the risk of bleeding which pose as the major disadvantage.
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| '''Rotational embolectomy''': As the name suggest, a rotational device is used to fragment the thrombus. In this, cardiac catheters are used, which does not require venotomy at the puncture site. The fragments are continuously aspirated.
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| '''Surgical embolectomy''': This procedure is typically limited to large medical centers (as it requires experienced surgeon and cardiopulmonary bypass).
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| *Indications
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| **Hypotensive patients in which thrombolysis is contraindicated.
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| **Embolus trapped within patent foramen ovale, right atrium or the right ventricle, as evident on Echocardiography.
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| *Benefits
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| **Among patients failing initial thrombolysis, surgical embolectomy was found to have fewer death rates and fewer major bleedings<ref name="pmid16608956">{{cite journal| author=Meneveau N, Séronde MF, Blonde MC, Legalery P, Didier-Petit K, Briand F et al.| title=Management of unsuccessful thrombolysis in acute massive pulmonary embolism. | journal=Chest | year= 2006 | volume= 129 | issue= 4 | pages= 1043-50 | pmid=16608956 | doi=10.1378/chest.129.4.1043 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16608956 }} </ref>.
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| *Special Considerations
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| **A study had shown the presence of extrapulmonary thrombus in 13 out of 50 patients undergoing surgical embolectomy, thus emphasizing the need of [[transesophageal echocardiography]] (TEE)<ref name="pmid15337008">{{cite journal| author=Rosenberger P, Shernan SK, Mihaljevic T, Eltzschig HK| title=Transesophageal echocardiography for detecting extrapulmonary thrombi during pulmonary embolectomy. | journal=Ann Thorac Surg | year= 2004 | volume= 78 | issue= 3 | pages= 862-6; discussion 866 | pmid=15337008 | doi=10.1016/j.athoracsur.2004.02.069 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15337008 }} </ref>. TEE should be performed before or during the procedure to look for extrapulmonary thrombus. Extrapulmonary thrombus are thrombus present in [[right atrium]], [[right ventricle]], or [[inferior vena cava]].
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| ==Relation to PTE==
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| Pulmonary thrombectomies and [[pulmonary thromboendarterectomy|pulmonary thromboendarterectomies]] (PTEs) are both operations that remove thrombus. Aside from this similarity they differ in many ways.
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| *PTEs are done non-emergently whilst pulmonary thrombectomies are typically done as an emergency procedure.
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| *PTEs typically are done using hypothermia and full cardiac arrest.
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| *PTEs are done for chronic pulmonary embolism, thrombectomies for severe acute pulmonary embolism.
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| *PTEs are generally considered a very effective treatment, surgical thrombectomies are an area of some controversy and their effectiveness a matter of some debate in the medical community.
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| ==See also==
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| *[[Pulmonary embolism surgery|Pulmonary embolism Surgical Therapy]]
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| *[[Pulmonary embolism]]
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| *[[Heart-lung machine]]
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| *[[Pulmonary embolism ACC/AHA guidelines surgical embolectomy|ACC/AHA Guidelines Surgical Embolectomy]]
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| ==References==
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| {{Reflist|2}}
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| [[Category:Thoracic surgery]]
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| [[Category:Surgical procedures]]
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